Objectives To evaluate clinicopathological features and survival outcomes of malignant non-dysgerminomatous germ cell tumor (MNDGCT) of the ovary.

Methods We retrospectively recorded clinicopathological and therapeutic data of 64 patients with MNDGCT of ovary treated at the Salah Azaiez Institute of Tunisia between 1970 and 2012.

Results The median age was 26 years (range7–75 years).The most frequent subtype was immature teratoma (n=27, 42.18%) followed by yolk-sac tumor (n=15, 23.43%) and mixed germ cell tumor (n=11, 17.18%).Most of the patients had stage I and II disease (41 cases, 64.1%) while 17 (26.6%) and 6 (9.3%) were staged III and IV disease, respectively. Radical surgery was performed in 23 patients (35.8%) and conservative surgery in 41 patients(64.2%) associated with lymph node dissection in 19 cases. Complete macroscopic resection was obtained in 48 patients (78.68%) and lymph node metastasis was observed in 41.5% of cases. Adjuvant chemotherapy was indicated in cases in 54.68% of cases. After a mean time follow-up of 74 months (7–182 months), complete remission was observed in 47 patients. The 5-year progression-free survival (PFS) was 73.5%.The 5 year overall survival (OS) was 82.23% and was significantly decreased in young patients ≤15 years (49.5% vs 89.4%;p=0.003), advanced stage (94.6% in stage I-II vs 59.8% in stage III-IV;p=0.01) and macroscopic residual disease (88.9% vs 52.9%;p=0.02).No difference in OS was noted following stratification by tumor size ≤or>20cm (84.7% vs 74.6;p=0.44) and conservative or radical surgery (89.8% vs 70%;p=0.34)

Conclusions Macroscopic residual disease as well as advanced FIGO stage and age are the main prognostic factors in MNDGCT.